Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management

Impact of School Nurses on Children with Food Allergies: A Comprehensive Review

BACKGROUND

Food allergies (FAs) are a significant public health concern, affecting 6-8% of children worldwide, with a growing prevalence. Schools are high-risk environments for allergic reactions, including anaphylaxis, which can be life-threatening. Alarmingly, up to 16-18% of children with FAs experience allergic reactions at school, often due to accidental exposure. Additionally, up to 25% of anaphylactic reactions in schools occur in children with no prior diagnosis of FA, emphasizing the critical need for school-wide preparedness and robust emergency action plans. School nurses play a pivotal role in managing FAs through individualized health plans, emergency preparedness, staff training, and psychosocial support. This review aims to evaluate the multifaceted role of school nurses in ensuring the safety, health, and psychosocial well-being of children with FAs. It also seeks to identify systemic challenges and gaps in allergy management to inform targeted interventions and future research.

METHODS

This comprehensive review synthesizes evidence on the role of school nurses in FA management. A systematic literature search was conducted across PubMed, CINAHL, Scopus, and Cochrane, targeting studies published between 2014 and 2024. The search identified 6313 articles, of which 5490 remained after duplicate removal. After title and abstract screening, 60 articles were selected for full-text evaluation, with 59 included in the final review. Thematic analysis identified six domains: preventive measures, emergency preparedness, communication, health outcomes, psychosocial support, and systemic challenges.

RESULTS

The review highlights the critical contributions of school nurses to FA management. They improve safety by implementing Individualized Health Plans (IHPs) and Emergency Action Plans (EAPs), ensuring timely administration of epinephrine and reducing delays during emergencies. Preventive strategies, such as allergen-free zones and comprehensive training for staff, minimize exposure risks. Psychosocial interventions led by nurses alleviate stigma, bullying, and anxiety, enhancing the quality of life for children with FAs. Despite these benefits, barriers persist, including insufficient nurse-to-student ratios, limited access to emergency resources like stock epinephrine, and disparities in allergy management across socioeconomic and geographic contexts.

CONCLUSIONS

School nurses are integral to managing FAs, ensuring safety, fostering inclusion, and addressing psychosocial needs. Addressing systemic barriers and ensuring equitable resource distribution are essential to optimize their impact. Future research should focus on the long-term outcomes of nurse-led interventions, strategies to reduce disparities, and the potential role of digital tools in improving allergy management.

Disparities in allergy and asthma prevalence among schoolteachers

BACKGROUND

Evidence suggests that school factors influence the prevalence of allergic diseases in students. However, little is known about how such factors affect the health of teachers.

OBJECTIVE

We sought to compare the prevalence of allergic and respiratory conditions among teachers from urban, suburban, and rural schools.

METHODS

Electronic survey data were collected from a random sample of prekindergarten through grade 12 teachers in Massachusetts. Comparisons were made between teacher demographics and allergic respiratory symptoms.

RESULTS

Of the 398 respondents, median (SD) age was 45 (12.32) years; 71.8% of teachers taught in suburban schools, 76.6% were female, and 87.1% were White, similar to teacher demographics collected by the Massachusetts Department of Higher Education. Although there were more female teachers, male teachers more frequently reported adverse breathing symptoms, such as wheezing (P = .007). Over half of rural teachers (54.54%) experienced respiratory symptoms such as disrupted sleep due to coughing compared to 34.61% of suburban schoolteachers (P = .03). Almost half (48.26%) of public schoolteachers experienced exercise-induced chest pain compared to 37.03% of private schoolteachers (P = .05). A higher proportion of urban schoolteachers with asthma commonly missed school as a result of food allergy compared to suburban and rural schoolteachers with asthma (P = .02). In teachers undiagnosed with asthma, associations existed between school absences and nighttime awakening due to trouble breathing (P < .0001), persistent cough (P = .002), and sore throat (P < .0001) CONCLUSIONS: Rural and public teachers reported proportionately more respiratory symptoms compared to suburban and private teachers, suggesting disparities. Future studies addressing evidence-based solutions are needed.

Food Insecurity and Health Inequities in Food Allergy

PURPOSE OF REVIEW

The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy.

RECENT FINDINGS

There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders. Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.

Psychosocial Impact of Food Allergy on Children and Adults and Practical Interventions

PURPOSE OF REVIEW

IgE- and non-IgE-mediated food allergies are increasing in prevalence in children and adults worldwide. A food allergy diagnosis can be associated with a sense of overwhelm and stress and commonly has a negative impact on quality of life.

RECENT FINDINGS

While there is an increased recognition of the psychosocial effects of food allergy, the current research reflects the experience of mostly White, well-educated wealthier populations. Some studies have now explored the psychosocial impact among other populations; however, further study is needed. It is important that physicians and allied health professionals screen for the potentially negative psychosocial effects of food allergy and provide education to promote safety and self-efficacy at each visit; however, time may be a limiting factor. Numerous validated questionnaires are now available to help assess the psychosocial impact of food allergies. Allergy-friendly foods are typically more expensive, and thus, it is imperative that physicians screen for food insecurity as well. Educational resources should be offered regarding living well with food allergies at each visit. For patients and families experiencing anxiety or food allergy burden that is difficult to manage, referral to a mental health provider should be considered. Resources regarding programs to help accessing safe foods should also be available. Further research is needed among diverse populations focusing on interventions to best support patients and families with food allergy.

Impact of socioeconomic factors on allergic diseases

Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.

Historical and social science perspectives on food allergy

This article provides an overview of the insights social scientists, historians and other health humanities scholars have made to our understanding of food allergies. It shows how humanities and social science scholars have tended to address three pivotal issues related to food allergies: first, they have addressed the epidemiology of food allergies, including the apparent rise in the rate of food allergies and the emergence of theories that purport to explain why food allergies may be increasing. These include theories related to changes in food consumption and the hygiene hypothesis. Second, humanities and social science scholars have researched how risks related to food allergies have been constructed, understood, experienced and mitigated. Third, humanities and social science scholars have investigated the experiences of food allergy sufferers and those who care for them, providing valuable qualitative insights that can inform how we respond to food allergy and our understanding of the aetiology of food allergy. The article concludes with three recommendations. First, there should be a more interdisciplinary approach to food allergy research that involves social scientists and health humanities scholars. Second, humanities and social sciences scholars should be more willing to unpack and scrutinise the theories put forward to explain the aetiology of food allergies, rather than accepting them at face value. And finally, humanities and social sciences scholars can play a major role in ensuring that the experiences of patients and their carers are articulated and fed into debates about food allergy, including its causes and how to respond to it.

Social disparities in early childhood prevention and management of food allergy

Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.